Provider Demographics
NPI:1942079488
Name:ANDERSON, KRISTY LYNN (NAC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1942
Mailing Address - Country:US
Mailing Address - Phone:509-710-2430
Mailing Address - Fax:
Practice Address - Street 1:423 E DALTON AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1942
Practice Address - Country:US
Practice Address - Phone:509-710-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60618777376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide